Congress scapegoats CDC, must fund Zika testing
It’s no secret that Zika is a growing concern in the U.S. With the number of cases rising, fast and accurate testing is a necessity. However, many Americans are being caught off guard by the Center for Disease Control and Prevention (CDC) prolonging the testing process and leaving many potential cases undiagnosed. In July, the CDC released a flowchart that broke down who should be tested into three main groups: pregnant women who have traveled outside of the country, people that have shown symptoms, and sexual partners of people that have shown symptoms. These strict guidelines shut out groups like women who have traveled recently and plan to become pregnant. Guidelines for men are even stricter, with testing opportunities fewer and further between. Anger with the CDC has mounted as people go undiagnosed, but the source of the problem seems to lie elsewhere. As usual, it can be traced back to the gridlock in Congress.
The first case of Zika was reported in the U.S. on January 15, 2016 when a baby was born in Hawaii to a mother that had previously lived in Brazil. Then came the four cases in Miami, the first time Zika had been locally transmitted in the continental U.S. The CDC began to advise against traveling to known Zika areas and America listened to its advice. But for those that chose to travel to events such as the 2016 Summer Olympics in Rio, they were not able to find solace in the CDC’s testing policies. All the CDC could do was warn against travel and encourage long sleeves in places like Florida.
In August, the CDC spent $2.5 million on lab equipment to increase their capacity to test for Zika, a small price in comparison to the $1.9 billion that President Obama asked for in February to fight the expansion of the disease. Despite this influx of new equipment, the CDC still remained strict in its guidelines of who could be tested. Those at the bottom of the chain waiting for tests, however, still felt neglected.
While the restrictions are in place to prevent an overload of testing, their exclusivity makes doctors hesitant to diagnose Zika for fear of not being able to give their patient a definitive answer or proper treatment for weeks. This could lead to someone with Zika being misdiagnosed. It also makes health insurers reluctant to fund the testing unless the doctor has told them that the patient appears ill or pregnant.
There are two main reasons that the CDC seems to have set these guidelines about testing. The first is the complicated history Zika funding has with Congress. Senate Democrats blocked the initial attempt to pass a $1.1 billion Zika bill. While there seems to be no reason to block a bill dedicated to funding the fight against Zika, there were some hidden clauses snuck in by Republicans. Included in the bill were restricted access to contraceptives and weaker environmental restrictions on pesticides. These provisions tried to ride the coattails of a bill that seemed sure to make it all the way to the oval office.
The failure of a new $1.1 billion dollar bill with revisions last week has divided the Senate even further with Democrats blaming Republicans of trying to sneak funding away from other sectors of the governments and Republicans calling Democrats out for a lack of bipartisanship. Meanwhile the CDC, which was supposed to get $394 million of funding from this bill, has made it known that they will run out of money at the end of this month.
The second factor impacting the access to Zika testing is the number of tests being ordered. At the beginning of September, roughly 600 people were tested for Zika with several others unable to get access to the tests. Due to a lack of funding, however, CDC hasn’t been able to expand the amount of tests they can run which has led to these stricter guidelines. Much of the anger seems to be focused on the CDC, but it has made it known that they were going broke for a while. It isn’t the one that decides how much of the budget pie it gets, Congress is, but with tensions running high it seems like the most immediate reaction is to shoot the messenger.
Testing for Zika isn’t exactly a black and white process either. There are certain tests that have only been approved by the FDA in emergency cases. One of these emergency tests is Trioplex real-time reverse transcription-polymerase chain reaction (rRT-PCR). It detects the RNA of Zika virus. Regular rRT-PCR are permitted for use on people with and without symptoms of Zika. Results for this test are obtained through blood and urine samples. Serologic Zika tests look for antibodies that develop in the first week of illness and are specifically for those that actually have the Zika virus. These tests can take time to show results and sometimes require an additional follow-up.
The amount of time needed for testing puts a serious bind on newly pregnant women who have recently traveled that would consider abortion. With the most cases happening in Florida, it isn’t really convenient that their abortion laws are more on the strict side. The law allows abortions during the first two trimesters, after that it is only permissible if “necessary to save life or preserve health of mother." This gives women roughly 28 weeks after conceiving to make a decision and with tests taking several weeks due to how many are being ordered, it doesn’t leave much time to make that decision.
The CDC has also not given couples who have traveled but would like to conceive many options either. If you or your partner has traveled to a Zika country, their suggestion is to wait eight weeks before trying to become pregnant. Their guidelines don’t mention trying to get tested at all. The only instance where they suggest talking to a healthcare provider is if either you or your partner lives in a Zika area. Even then it doesn’t outright say get tested and talking to a doctor could just lead to a more prolonged diagnosis in this case.
In addition to the rules being cloudy for whom to prioritize with women, it’s even harder to understand the advice of the CDC for men. While the disease can be spread through the semen of an infected man for six months, there is currently not a way to test semen for Zika. The World Health Organization (WHO) recommends six months of protected sex for men who have been exposed to Zika, not testing.
The CDC is facing pressure from all ends of the spectrum from Congress all the way down to citizens that fear for their health. The limited access to testing has made it difficult not only for women who want to get pregnant, but for men who would like to know if they risk the possibility of spreading Zika to their partners. It seems that stricter guidelines are the only way the CDC can cover their monetary deficit, even if it means leaving several others undiagnosed. Congress must close the funding gap, or people will continue to fall through the cracks. The CDC’s hands are tied, so citizens need to put pressure on the source of the problem and make Congress appropriate the funds the CDC needs to function and protect Americans.